- Medicare Hospice Quick Reference Sheet
- Hospice Certifying Physician Medicare Enrollment Information
- Hospice Notice of Election Termination/Revocation
- Hospice Room and Board Denials
- Professional Services During a Patient Hospice Election
- Tips to Facilitate the Change of Ownership Process
- Service Intensity Add-on Payment
- Counting 60-Day Election Periods
- Untimely Filed Notice of Election Circumstance Exception: Medicare Beneficiary Is Granted Retroactive Medicare Entitlement
- Hospice Billing Codes Chart
- Appropriate Use of Occurrence Code 27 and Occurrence Span Code 77
- Avoiding Reason Code U5181: Appropriate Use of Occurrence Code 27/Occurrence Span Code 77
- Hospice Notice of Change of Ownership
- Filing an Electronic Notice of Change of Ownership (TOB 8XE)
- Hospice Change of Ownership
- Filing an Electronic Notice of Cancelation (Type of Bill 8XD)
- Filing an Appeal for Claims Rejected for an Untimely Hospice Notice of Election
- Filing an Electronic Notice of Transfer (Type of Bill 8XC)
- Counting 60-Day Election Periods - Leap Year
- Hospice Site of Service Codes
- Billing Hospice Physician, Nurse Practitioner and Physician Assistant Services (Related To Terminal Diagnosis)
- Correcting Hospice Claims Sequentially to Avoid Reason Code U5181
- Common Working File System Edit F5052 and M5052
- Hospice Visit Reporting
- The Medicare Hospice Benefit: Effects on Other Provider Types
- Counting 90-Day Election Periods - Leap Year
- Reporting Hospice Discharges, Revocations and Transfers
- Filing an Electronic Notice of Termination-Revocation of Election (Type of Bill 8XB)
- Avoiding Reason Code 7C625: Appropriate Use of Remarks on Final Hospice Claims
- Notice of Election: Timely Filing of Hospice Elections
- Hospice Claim Submission Job Aid
- Direct Mailing Notification to Hospice Providers Regarding the Hospice Benefit Component, VBID Model, Participating MAOs
- Counting 90-Day Election Periods
- Hospice Quality Reporting Program
- Filing an Electronic Notice of Election (Type of Bill 8XA)
- Hospice Prescription Drug and Infusion Pump Reporting
- Hospice Caps Job Aid
- Value-Based Insurance Design Model Hospice Benefit Component Overview
- Documentation for Hospice Transfers
- Hospice Billing Instructions for Influenza, Pneumococcal and Hepatitis B Vaccines
- Appropriate Use of Condition Code 85
- How to Correct/Avoid Reason Code U5150
- General Inpatient Check Off List
- Hospice Transfers Job Aid
- Medicare Two Tier Routine Home Care Payment Rate
- Canceling a Hospice Notice of Election
- Hospice Pricer Tool Quick Reference Tool
- How to Bill When the Hospice Face-to-Face is Late from a Previous Benefit Period
- Site of Service Codes for Continuous Home Care and General Inpatient Care Level of Service
- Hospice Payment Rates
- Billing Medicare for a Denial - Condition Code 21
- Reminder on Deleting Revenue Code Line(s) in the Fiscal Intermediary Standard System Direct Data Entry System
Filing an Appeal for Claims Rejected for an Untimely Hospice Notice of Election
Table of Contents
Background Information
With the implementation of CR 8877, for claims with dates of service on or after 10/1/2014, timely-filed hospice NOEs must be filed within five calendar days after the hospice admission date. A timely-filed NOE is an NOE that has a receipt date within five calendar days after the hospice admission date and is subsequently processed in status/location P B9997.
In instances where a NOE is not timely-filed, the days of hospice care from the hospice admission date to the date the NOE is submitted to and subsequently processed by the Medicare contractor will not be covered. The hospice shall report these non-covered days on the claim with an OSC 77, and charges related to the these days shall be reported as non-covered, or the claim will be returned to the provider. The non-covered days will be provider liable, and the beneficiary cannot be billed for them.
A hospice may request an exception to the timely filing NOE rules which, if approved, waives the consequences of filing a NOE late. The four circumstances that may qualify the hospice for an exception to the consequences of filing the NOE more than five calendar days after the hospice admission date are as follows:
- Fires, floods, earthquakes, or other unusual events that inflict extensive damage to the hospice’s ability to operate;
- An event that produces a data filing problem due to a CMS or Medicare contractor systems issue that is beyond the control of the hospice;
- A newly Medicare-certified hospice that is notified of that certification after the Medicare certification date, or which is awaiting its user ID from its Medicare contractor; or,
- Other circumstances determined by the Medicare contractor or CMS to be beyond the control of the hospice.
Note: Provider billing errors are in the control of the hospice; therefore, they will not meet the criteria for a valid exceptional circumstance.
Even if a hospice believes that exceptional circumstances beyond its control are the cause of its late-filed NOE, the hospice must still file the associated claim with the OSC 77 to identify the non-covered, provider liable days. The hospice will also report a KX modifier with the site of service code (Q HCPCS codes) associated with the earliest dated level of care line on the claim along with remarks to explain the reason for the late NOE. The KX modifier will prompt National Government Services to review the remarks, and if needed, request documentation supporting the request for an exception. Based on that documentation, National Government Services will determine if a circumstance encountered by a hospice qualifies for an exception.
How are claims processed after reviewed by the claims auditor?
If National Government Services approves the request for an exception, we will process the claim with the CWF override code and remove the submitted provider liable days, which will allow payment for the days associated with the late-filed NOE. If National Government Services finds that the documentation does not support allowing an exceptional circumstance, we will process the claim as submitted.
What are the next steps if the claim is rejected by the claims department for untimely filed NOE?
When the claims department processes the claim as submitted, and you feel that the exceptional circumstance has been met, you must submit an appeal through the redetermination process. It is not appropriate to submit an adjustment claim in this situation. If an adjustment claim is submitted, the claim will return to the claims department and once again be denied.
Appeals may be filed by mail or electronically through NGSConnex. To request an appeal in writing, complete the CMS-20027 Medicare Redetermination Request Form and return to the appropriate National Government Services address. If you are an existing NGSConnex user, you can initiate a redetermination by completing the application in NGSConnex. For further instructions on submitting a redetermination via NGSConnex, please visit the appeals section for step-by-step instructions.